Healthcare Provider Details

I. General information

NPI: 1588425847
Provider Name (Legal Business Name): MIGUEL A HERNANDEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6708 NW 191ST TER
HIALEAH FL
33015-2444
US

IV. Provider business mailing address

6708 NW 191ST TER
HIALEAH FL
33015-2444
US

V. Phone/Fax

Practice location:
  • Phone: 786-277-6024
  • Fax: 561-808-8406
Mailing address:
  • Phone: 786-277-6024
  • Fax: 561-808-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number9393491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: